Magnetic resonance imaging with cochlear implants and auditory brainstem implants: Are we truly practicing MRI safety?

Abstract

Objective Our objective is to evaluate the safety in patients with cochlear implants (CIs) and auditory brainstem implants (ABI) undergoing 1.5 Tesla (T) magnetic resonance imaging (MRI). Secondly, we want to raise awareness on CI and MRI safety, and advocate for continued improvement and advancement to minimize morbidity for our CI patients. Methods Retrospective case series from 2006 to 2018 at a single tertiary academic center. Data was collected on patients with CI or auditory brainstem implants undergoing MRI. Outcomes collected include demographic data, age at time of MRI, MRI characteristics, complications, CI manufacturer, and image quality. Results Eighteen patients with CI or ABI collectively underwent a total of 62 MRI scans. Five of 15 (33%) CI patients with magnet had complications: five total of 24 MRI scans (21%). Two patients had magnet removal prior to 29 MRI scans without complications. Four of five MRI‐related complications were equipped with a U.S. Food and Drug Administration‐approved head wrap. Three of five required a trip to the operating room to explore and reposition the CI magnet; two could not complete MRI secondary to pain. Of the complications, two were Cochlear (Sydney, Australia), two Advanced Bionics (Valencia, CA), and one MED‐EL (Innsbruck, Austria). Synchrony model (MED‐EL) had 0 of seven complications, with a total of 19 MRI scans, which features a freely rotating and self‐aligning magnet. Conclusion Our series offers a diverse number of CI manufacturers and is in accordance with other literature that CI MRI‐related adverse events are occurring at an unacceptable frequency. We can promote CI MRI safety through our institutions' MRI CI patient protocols, raise awareness that diagnostic MRI benefits must outweigh CI‐related complications, and advocate for continued industry technological innovation. Level of Evidence 4 Laryngoscope, 129:482–489, 2019

Management of transmodiolar and transmacular cochleovestibular schwannomas with and without cochlear implantation

“…7a; [46,49,51]). Second, the magnetic field can induce significant heat and force, which may lead to pain and magnet dislocation, necessitating revision surgery [14,23,47,49]. Temporary magnet removal or correct securing of a head splint can be used to overcome these problems.…”

Ipsilateral Cochlear Implantation in the Presence of Observed and Irradiated Vestibular Schwannomas

“…Shew et al recently called the safety and efficacy of MRI in this population into question. 31 They reported a 33% complication rate (including pain and magnet displacement) in 15 CI patients undergoing MRI despite four of the five patients having documented FDA approved head wrap, although infiltration of local was not noted. Three patients required take back to the operating room for magnet replacement.…”

Two-phase survey on the frequency of use and safety of MRI for hearing implant recipients

“…It has been reported in the literature that HIs, such as cochlear implants (CIs), auditory brainstem implants (ABIs), middle ear implants, or bone conduction devices, are associated with unwanted complications during an MRI scan. These complications include large artefacts or distortions on the MR image, distortion or dislocation of the implant magnet, weakening of the implant magnet, demagnetization, or an increase in temperature in the vicinity of the implant [3,[9][10][11][12][13][14][15][16][17].…”